Provider Demographics
NPI:1518038504
Name:BUTLER, NANCY A (DPM)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-0528
Mailing Address - Country:US
Mailing Address - Phone:716-444-2159
Mailing Address - Fax:716-743-9688
Practice Address - Street 1:8333 BLACK WALNUT DR
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1559
Practice Address - Country:US
Practice Address - Phone:716-444-2159
Practice Address - Fax:716-743-9688
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY003708213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01034422Medicaid
NY01034422Medicaid
NYIA0740Medicare PIN
NYB40801Medicare PIN